To find out if they could predict how long an older person will continue to live, Duke University researchers used 1507 blood samples and lifestyle data from participants in the D-EPESE study that was conducted in New Haven, CT, in 1992. Participants were at least 71 years old when the study started, and the Duke researchers counted their years to death over the following 27 years (eBioMedicine, Sept 28, 2022;85(3):104292). The strongest predictors of longevity were levels of small HDL particles (described below) and smoking history. Their findings are particularly dependable because their blood was drawn in 1992, when fewer people were taking drugs such as statins that would make tests of blood lipid levels less significant. Other predictors of longevity included evidence of physical and mental activity.

Lifestyle Factors
People over 70 years of age were more likely to live at least 10 years longer if they had the following lifestyle factors:
• Ability to groom themselves. Lack of the motor control required for personal grooming was a very strong predictor of a shorter life.
• Ability to perform daily tasks such as grocery shopping and housework (Rosow-Breslau ability to do heavy housework test).
• Being a non-smoker.
• Having a high score on a cognitive function test (Short Portable Mental Status Questionnaire or SPMSQ).
• Exercising regularly. The greater the frequency and intensity of exercise, the more likely a person was to live longer.

Blood Test Factors
Blood test results associated with a longer life included:
• Having high levels of small particle HDL, total protein, albumin, and/or percentage of normal lymphocytes
• Having low normal levels of GlycA (a marker of inflammation), creatinine (kidney function) and/or GGT (liver test)

Small Particle HDL: The Most Reliable Predictor of Longevity
Of all the blood tests in the study, having high concentrations of small HDL particles (<9 nm diameter) was the best predictor of longevity. The standard tests for lipids used by most doctors today (total cholesterol, HDL, LDL and triglycerides) were not as dependable in predicting lifespan as the test for small size HDL particles.

The main function of HDL cholesterol is to carry cholesterol from the blood and tissues to the liver, where it can be removed from the body so it does not form arterial plaques (Circ Res, 2015;116(7):1133–1142). The prevention of arterial plaques is associated with higher levels of small HDL particles, not with the amount of total HDL cholesterol (Lancet, November 2022;85). People who have extensive plaques in their arteries have lower blood levels of small particle HDL (J Lipid Res. 2017;58(3):600–606). It is the small HDL particles that bind, neutralize and clear endotoxins and cholesterol from arterial plaques, not the large HDL particles (Innate Immun, 2021;27(1):3–14). Therefore, it is the small HDL cholesterol particles that dampen down overactive immunity (inflammation) that causes plaques to form in arteries and then break off to cause heart attacks (Handb Exp Pharmacol, 2015;224:483–508). The authors of the Duke study conclude that “These results suggest that measures of small HDL particles are likely more informative than standard lipid panels for longevity prediction in a clinical setting” (eBioMedicine, Nov 1, 2022;85:104292). Thus, a test for the concentration of small particle HDL may be more useful than than the standard tests for HDL, LDL and triglycerides that are ordered by most doctors.

My Recommendations
This study found that high levels of small particle HDL are a strong predictor of longevity. However, the amount of small particle HDL in your bloodstream appears to be genetic, and as far as we know today, it cannot be improved with lifestyle changes or drugs.

The lifestyle factors associated with increased longevity include anything that uses your muscles or your mind. The more debilitated you are, the shorter your expected lifespan and the more active you are, the longer your expected lifespan.